Claims handling

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Examiner assignment

When a First Report of Injury is filed, the claims examiner is the primary contact for coordinating all actions related to the treatment and finalization of the claim.  The employer and claimant will be notified of the name and phone number of the examiner assigned to the claim.

A specific examiner may be assigned to handle all claims for a policyholder with a large work force and significant claim activity.

Claim investigation

A claim may be investigated when:

• There is a question regarding whether the injury arose out of and in the course of employment.
• Additional medical information is needed to determine if previous injuries are involved.
• Additional information for a third-party claim is needed.
• Written statements are needed to determine the exact nature of the injury.

During an investigation, the worker, the employer and any witnesses to the injury may be contacted by an investigator, who will schedule appointments to take recorded statements. It is the employer's obligation to cooperate fully with State Insurance Fund personnel during a claim investigation.

Medical review

The State Insurance Fund's Medical Review Unit includes physician consultants and nurse consultants. The nurse consultants will assist the claims staff when complicated medical issues are involved. They will also assist a treating physician, when requested, to help coordinate treatment, or research and locate options for uncommon procedures or treatments.

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